Launceston General Hospital

In the real-time energy management of offshore islanded microgrids, determining the optimal operating points of storage systems, particularly in hydrogen-based storage, poses significant challenges. These arise from the stochastic nature of offshore Renewable Energy Sources (RES), variable power demand, and the volatility of hydrogen systems. To address these, a novel objective function has been developed that integrates electrolyzer system efficiency into the Energy Management Strategy (EMS) of a DC microgrid. Unlike most existing literature, which considers electrolyzer efficiency as a constant, this work treats efficiency as a dynamic variable that depends on operating current, temperature, and pressure. The behavior of the electrolyzer efficiency with respect to these parameters is modeled, verified, and subsequently incorporated into the EMS. A MINLP based EMS is developed to implement the proposed formulation, and its effectiveness is validated by demonstrating optimal microgrid performance under the above scenario. Notably, the impact of optimal temperature and pressure control is evidenced by electrolyzer efficiency improvements of 1.7% and 3.1% in the efficiency-focused and multi-objective scenarios, respectively. The proposed EMS is evaluated against a rule-based and heuristic (PSO) methods. In the cost-based case, the developed method shows 36.5% and 0.04% cost reductions relative to the rule-based approaches, and a 0.39% reduction relative to PSO. In the efficiency-based scheme, it attains 0.10% efficiency gain over PSO for the optimal temperature-pressure method, and in the multi-objective case, it delivers 7.40% efficiency gain versus PSO. • Novel optimization with electrolyzer efficiency for offshore islanded DC microgrids. • Electrolyzer efficiency modeled dynamically via current, temperature, and pressure. • Multi-objective framework balances cost and efficiency in flexible microgrid EMS. • Sensitivity to electrolyzer operating conditions is analyzed. • EMS validated against rule-based and metaheuristic approaches.

Abstract Durvillaea spp. (Fucales) occur on wave-exposed coasts in parts of the southern hemisphere. In Tasmania, Australia, a small but economically valuable industry (> US$1.5 million GVP) harvests beach-cast Durvillaea potatorum , primarily for alginates and liquid plant biostimulants. Currently, demand for D. potatorum biomass exceeds supply, prompting interest in aquaculture to sustainably increase production. However, fundamental hatchery methods required for its cultivation are not well understood. We conducted a series of experiments to determine optimal conditions for gamete release, fertilisation, and juvenile growth in a hatchery setting. Releasing gametes for 10 min at 14 °C produced consistently high egg densities (mean ± SE: 12,720 ± 1020 cm −2 tissue) and fertilisation rates peaked (89 ± 4%) when reproductive tissue was held overnight and gametes were released at 14 °C. Moreover, ~ 50% of male and female gametes were released within 10 min and > 90% within one hour. Three growth experiments showed that: (i) the highest growth rate was found by first holding the samples in the dark overnight at 14 °C and then using a gamete-release temperature of 18 °C, with juveniles reaching a mean length of 1.2 mm ± 0.1 SE and width of 0.29 mm ± 0.02 SE after 60 days at 14 °C and a light level of 35 µmol photons m −2 s −1 (12 h light: 12 h dark photoperiod); (ii) an irradiance level of 95 µmol photons m −2 s −1 for maximise growth of juveniles; and (iii) nutrient medium and temperature influenced growth, with the best performance in F/2 medium at 15 °C after 30 days (mean length 0.9 ± 0.2 mm; width 0.38 ± 0.01 mm). Growth of juvenile D. potatorum was poor in media containing ammonium (NH 4 + ), such as Provasoli’s Enriched Seawater (PES) and seawater enriched with N and P, at similar concentrations to PES, suggesting NH 4 + toxicity for early life stages at high concentrations. These results represent a significant step toward establishing effective hatchery methods for Durvillaea spp . and other Fucales more broadly, supporting future at-sea cultivation.

To explore the experiences and perceptions of health and healthcare of clients of a co-designed, community-based service for people with frequent hospital admissions. This qualitative study used semi-structured interviews guided by a schedule that covered each participant's experience and perception of their health and healthcare and experience of receiving care from the service; what is important to them when receiving care; and what, if any, effect being a client of the service had on their health and well-being. Interviews took place in participants' homes, were audio-recorded, transcribed verbatim and checked for accuracy. Participants were able to amend their transcript. Using thematic analysis informed by grounded theory, data were independently and iteratively analysed by two investigators and data saturation was reached. The study was guided by principles of qualitative rigour. A nurse-led, multidisciplinary, community-based service comprising a nurse manager, GP, social worker, allied health assistant and administration assistant for people with frequent admissions at a public hospital in Tasmania, Australia. Any past or existing client was eligible to participate. Twenty were interviewed. Their median age was 78 years, 50% were female and 55% lived alone. Three themes were identified: (i) the challenges of ageing, (ii) complex care needs require intensive multidisciplinary holistic care and (iii) relationships are central to care and healthcare delivery. The three themes together formed a central organising theme: time to care. Having 'time to care' enabled healthcare workers to provide biomedical and psychosocial care and support and help participants address their challenges of ageing. It also allowed the development of trusting and respectful relationships that were essential to participants when receiving care. To understand and support people with frequent admissions 'time to care' was essential. A range of healthcare workers were required to provide relational aspects of care, as well as individualised and time-intensive care that spanned medical, spiritual, mental and socio-economic dimensions across tertiary, social and community services. Diverse strategies may be needed to allow healthcare workers 'time to care'.

Abstract Introduction Textbook outcome is a composite tool to assess the quality of cancer care within an institution by evaluating several perioperative factors. Most studies assessing textbook outcomes after esophagectomy have been conducted in high-volume centres, achieving rates of up to 50%. To the best of our knowledge this is the first study to assess textbook outcomes after esophagectomy in a regional Australian hospital, providing a unique insight into the performance of this procedure in a country that has not widely adopted centralization of cases. Method A retrospective observational study was performed on patients that underwent esophagectomy at a single regional centre in Tasmania between January 2014 and December 2023. Textbook outcome was achieved when 10 criteria were met. The number of patients achieving each parameter was calculated, and several patients (age, gender, BMI, ASA), tumour (histology, T and N stage), and treatment (neoadjuvant therapy, surgical approach)-related parameters were assessed. Overall survival was also assessed. Results Sixty-five patients were identified. The overall textbook outcome rate was 32.3%. The most achieved parameters were R0 resection (100%) and no intraoperative complication (98.5%). The factors achieved least frequently were >15 lymph nodes (53.8%) and no reintervention (64.5%). A significant association was found between preoperative nodal stage and textbook outcome (P = 0.02). There was no difference in survival between patients with and without textbook outcomes. Conclusions Achieving higher rates of textbook outcomes remains a challenge, especially in the regional setting where access to services associated with higher rates of textbook outcomes may be limited.

LTI-03 is a novel inhaled therapeutic in development for idiopathic pulmonary fibrosis (IPF). LTI-03 has been shown to promote alveolar epithelial cell survival and reduce profibrotic protein expression in experimental models of lung disease. To evaluate the safety and pharmacokinetics (PK) of LTI-03 and effects on disease biomarkers in patients with IPF. This Phase 1b, randomized, controlled, dose-escalation study randomized 24 participants, 3:1 into 2 sequential dose cohorts, to receive inhaled LTI-03 (5 or 10 mg/day) or placebo for 14 days. The primary endpoint was the incidence of treatment-related adverse events (TEAEs). Exploratory analyses included PK and change from baseline in fibrosis-related and epithelial integrity-related biomarkers in plasma, peripheral blood mononuclear cells (PBMCs), and deep bronchial brushings (DBB). Inhaled LTI-03 was well-tolerated, with no treatment-related AEs leading to treatment discontinuation. All TEAEs were mild or moderate in severity. Cough was the most common TEAE and the only treatment-related TEAE experienced by more than 1 participant. There was no evidence of airway obstruction by symptoms or spirometry. LTI-03 did not induce inflammation (phosphorylated AKT) in PBMCs. In DBB samples, LTI-03 significantly reduced the expression of interleukin-11, chemokine ligand 7, thymic stromal lymphopoietin, and galectin 7; dose-related reductions were also observed for collagen type 1 alpha chain 1 and plasma surfactant protein D. Inhaled LTI-03 exhibited a favorable safety and tolerability profile over 14 days. Exploratory biomarker analyses suggest a positive effect on epithelial homeostasis and corresponding antifibrotic effects. Scientific Knowledge on the Subject: Current standard of care therapies for IPF do not halt or reverse disease progression, and systemic side effects commonly result in discontinued use. LTI-03 is a caveolin scaffolding domain (CSD) peptide formulated as an excipient-free dry powder for the treatment of IPF. It has demonstrated anti-fibrotic and epithelial protective effects in animal models of fibrosis and in IPF precision cut lung slices via putative replenishment of endogenous Cav-1 signaling, which is lost in fibrotic diseases.What This Study Adds to the Field: The results of this study support the conclusion that LTI-03 was well tolerated in patients with IPF at doses of 5 and 10 mg/day. Exploratory biomarker analyses from deep bronchial brushings suggested that positive pharmacodynamic effects were achieved on target cell types. Taken together, these results support the initiation of a Phase 2 efficacy study in patients with IPF. Rein Therapeutics, Inc. ("Rein") understands and acknowledges the need to share clinical study data with the research community in an open and transparent manner and has provided de-identified patient data in the manuscript. Rein will not consider further requests pertaining to clinical data outside of what has been accepted and published by the journal. Any queries regarding clinical study data must be submitted in writing to https://info@reintx.com . A data supplement for this article is available via the Supplements tab at the top of the online article.

Decarbonising aquaculture support vessels is pivotal to reducing greenhouse gas (GHG) emissions across both the aquaculture and maritime sectors. This study evaluates the technical and economic feasibility of deploying hydrogen as a marine fuel for a 14.95 m net cleaning vessel (NCV) operating in Tasmania, Australia. The analysis retains the vessel’s original layout and subdivision to enable a like-for-like comparison between conventional diesel and hydrogen-based systems. Two options are evaluated: (i) replacing both the main propulsion engines and auxiliary generator sets with hydrogen-based systems—either proton exchange membrane fuel cells (PEMFCs) or internal combustion engines (ICEs); and (ii) replacing only the diesel generator sets with hydrogen power systems. The assessment covers system sizing, onboard hydrogen storage integration, operational constraints, lifecycle cost, and GHG abatement. Option (i) is constrained by the sizes and weights of PEMFC systems and hydrogen-fuelled ICEs, rendering full conversion unfeasible within current spatial and technological limits. Option (ii) is technically feasible: sixteen 700 bar cylinders (131.2 kg H2 total) meet one day of onboard power demand for net-cleaning operations, with bunkering via swap-and-go skids at the berth. The annualised total cost of ownership for the PEMFC systems is 1.98 times that of diesel generator sets, while enabling annual CO2 reductions of 433 t. The findings provide a practical decarbonisation pathway for small- to medium-sized service vessels in niche maritime sectors such as aquaculture, while clarifying near-term trade-offs between cost and emissions.

This paper presents a novel submersible seaweed cultivation infrastructure designed to enhance seaweed growth through deep cycling. The system consists of a square grid of ropes for growing seaweed, supported by buoys, mooring lines, and innovative SubTractors—movable buoys that enable controlled submersion. The grid ropes are stabilized by four SubTractors, an array of small buoys, intermediate sinker weights and mooring lines anchored to the seabed. The SubTractors facilitate dynamic positioning, allowing the seaweed rope grid to be submerged below the thermocline—at depths of 100 m or more—where nutrient-rich deep water accelerates seaweed growth in offshore sites with low surface nutrient levels. Small buoys attached to the grid provide buoyancy, keeping the seaweed rope grid planar and near the surface to optimize photosynthesis when not submerged. This paper first describes the seaweed cultivation infrastructure, then develops a hydroelastic model of the proposed cultivation system, followed by a hydroelastic analysis under varying wave and current conditions. The results provide insights into the system’s dynamic behaviour, informing engineering design and structural optimization.

There is much contention over the causes and correlates of megafaunal extinctions at the end of the Pleistocene. A major role for human impact such as hunting has been discussed widely. If correct, the overkill hypothesis explains not only why large mammals in general were highly prone to extinction but suggests that extinction may have been selective within large mammals. Among other things, it has been argued that extinct large mammals tended to be large and have small brains. Here we test these hypotheses using a comprehensive global dataset of 22 ecological and life history traits mapped to 120 living and 14 extinct carnivore species. The data document occurrences within 260 distinct fossil assemblages that span the Late Pleistocene and Holocene. To address collinearity and phylogenetic autocorrelation, we first perform least‐squares orthogonalisation of the predictor variables and then use phylogenetic comparative methods to carry out regressions. Only basal metabolic rate and diurnality are robust predictors of extinction, even after accounting for phylogenetic and trait uncertainty. Furthermore, we show that living carnivores with high metabolic rates are more likely to be threatened and address the implications for conservation and the current extinction crisis.

<bold>Background:</bold> ‘Treatable traits’ is transforming the medical management of people with chronic lung disease. Its potential application beyond medical care is not well established but it could reform embedded practices regarding exercise training in pulmonary rehabilitation (PR) to potentially enhance its effectiveness. This study sought to develop a new model of personalised exercise training underpinned by treatable traits (ExTra+). <bold>Methods:</bold> 25 experienced PR clinicians and academics from Australia and New Zealand participated in online roundtable workshops over two days in Dec 2021. Findings informed an online international Delphi survey via DelphiManager. Clinicians and academics rated the importance of ExTra+ traits in terms of their impact upon exercise training via a 9-point Likert scale (higher = better). <italic>A priori</italic> consensus criteria involved median score, IQR and % of scores >7. <bold>Results:</bold> The roundtable meetings established a feasible prototype for ExTra+ and 24 candidate ExTra+ traits. The Delphi study was completed by 70 people from 14 countries (49% Australia, 16% United Kingdom, 35% other; 47% academics, 53% clinicians; median 11.5 [7.5-17] years PR experience). 61 completed round 1; 49 completed round 2 (80% retention). 12 traits achieved consensus in round 1; 4 more reached consensus after round 2. The top traits affecting exercise training were ‘dyspnoea’, ‘a recent lung-related event’ and ‘pulmonary hypertension’. <bold>Conclusion:</bold> ExTra+ sets a vital foundation to advance personalised exercise training in PR. The identified traits should be targeted for future research in this field.